NPI | 1558566612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 001814-1) |
Enumeration Date | 2007-06-19 |
Last Update Date | 2016-05-03 |